With most of the remaining cases of polio worldwide occurring in Nigeria, efforts have been stepped up to eradicate the disease once and for all.
"I do not really understand what happened. Aisha felt sick for weeks and got a high fever. Her legs have now started to get very weak and she has a hard time trying to stand up", explains Zainabu, a Nigerian mother whose daughter contracted polio, to Think Africa Press.
It is easy to forget the rows of iron lungs that filled hospital wards at the height of the polio outbreaks in the 1940s and 1950s, and it is easy to forget that it starts with a simple fever and ends in irreversible paralysis. We have forgotten what it is like to suffer from this undiscriminating disease.
Fortunately, polio has largely been eradicated, but for those living in the countries in which it remains endemic, the disease continues to be a threat. Launched in 1988, the Global Polio Eradication Initiative has seen over the years seen a 99% drop in the number of polio cases. In 1994, the World Health Organisation (WHO) Region of the Americas, consisting of 36 countries, was certified polio-free. In 2000, 37 more countries across the Western Pacific Region all gained that stamp of approval and the 51 countries of the European region followed in June 2002.
Today, polio's playground is largely restricted to three countries, which remain polio endemic. Whenever a global effort reaches its last mile, it serves to highlight the weakest among us - those with systemic problems unlike elsewhere. Regarding polio, these are Afghanistan, Pakistan and Nigeria.
Renewed efforts
Nigeria remains the only polio endemic country in Africa and bears the main global burden of the disease. In 2006, Nigeria had the highest number of polio cases worldwide with 1,122 cases, accounting for more than half the total global number for that year. 2011 was also a year of poor results with 62 reported cases of wild poliovirus (WPV), a two-thirds increase in cases of that kind compared to the previous year. And so far this year, there have been 97 reported cases - more than double the number of cases in Pakistan (44 cases) and close to four times that in Afghanistan (25 cases).
One of the main stumbling blocks to Nigeria tackling the disease effectively has been a problem of attitude. It was only in 2003 that in the northern state of Kano, Muslim leaders rejected the polio vaccination believing the campaign to eliminate polio was part of a Western plot to sterilise children. Vaccinations were halted temporarily, setting back efforts and putting neighbouring polio-free countries at risk, with the disease spreading to the likes of Ghana, Togo, Niger and Burkina Faso. To this day, northern Nigeria remains at the centre of the polio outbreak.
However, attitudes have since shifted over the past years. When the World Health Organisation's (WHO) Executive Board declared polio eradication a programmatic emergency for global public health at the start of 2012, for example, the Nigerian government responded by launching the National Polio Eradication Emergency Plan, which acts as a framework to provide accountability, ensures appropriate targeting of resources to the worst performing areas, and continually reviews policies and their effectiveness.
This was the beginning of a renewed impetus from the Nigerian government, and President Goodluck Jonathan has rarely missed an opportunity to reaffirm his country's commitment to eradicating the disease. In early March, he inaugurated a Presidential Task Force on Polio Eradication and gave the committee 24 months to eradicate the virus in Nigeria (sooner than the UN's 2015 deadline). In addition, Jonathan announced an increase in funding for the campaign from $22 million last year to $30 million for 2012.
Nevertheless, this September, WHO said Nigeria was not on track to eradicate the disease. Shortly after, the government of Jigawa state announced it would prosecute parents who reject the polio vaccine for their children with a possible sentence of between six months and one year imprisonment. However, while this new hard-line stance may prove effective, its target may be misguided; Nigeria's problem is perhaps no longer one of attitude, and recent research suggests knowledge of polio and how it is contracted and treated does exist among those most likely to be affected by it.
A battle on many fronts
Arguably, the problem up until now has been that polio eradication in Nigeria has been largely uncoordinated, made up of disparate and poorly-sustained efforts. Hopefully, this too is changing.
To begin with, in May of last year, Kano, which is said to have the highest number of polio cases, replaced all those in charge of polio immunisation hoping for a fresh approach. There also seems to be a stronger drive to get to the hard-to-reach populations of northern Nigeria, which has been matched with new ideas and methods, including the use of 'community champions' to encourage nomadic, pastoral families to take part in vaccination campaigns - a technique that has proven successful in other countries and for other diseases.
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Additionally, this year we saw the Gates Foundation once again partner with the Nigeria Governors' Forum, which set up the Immunisation Challenge. This programme set out specific objectives for each quarter of 2012, and the states that meet all criteria by the end of 2012 will be awarded a $500,000 grant from the Bill & Melinda Gates Foundation to support their health priorities. The award aims to encourage Local Government Areas to "play a visible role in promoting polio eradication, to release funds in a timely manner for immunisation, and to work closely with traditional leaders to make sure no children are being left out of immunisation activities".
Lessons are also being learned and implemented from India, the latest country to be removed from list of polio-endemic countries, including things as simple as spreading resources further by having more vaccination teams but made up of fewer people.
